August 23, 2018

The use of heated and humidified high flow nasal cannula has become increasing popular in the treatment of patients with acute respiratory failure through all age groups.  In part 1 we summarized how High Flow Nasal Cannula (HFNC) works.  In part 2, we will discuss the main indications for its use in adult and pediatric patients.

August 20, 2018

The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups.  I first started using it as a pediatric intensive care fellow, but had little knowledge of how it actually worked.  I noticed a few years after using it successfully in children, mainly with severe bronchiolitis, that we began to use it in the adult intensive care unit as well.  It seems over the past several years many studies have come out reviewing the mechanisms of action as well as its use in a variety of conditions.  In this part we will summarize how it works and for part 2 we will discuss the main indications for its use in adult and pediatric patients.

July 18, 2018

Have you ever heard an entire lecture on sinus tachycardia? Neither have I. It is the most common cardiac dysrhythmia seen in critically ill adults and kids, but it is the least frequently talked about. Sinus tachycardia may not be the sexiest rhythm and we don't think of cardioverting it or giving some new anti-arrhythmic drug, but it is a sign that something may be seriously wrong. To be fair, it’s not the sinus tachycardia we are really worried about, but rather what’s causing the sinus tachycardia that should be our main concern.

July 11, 2018

Background: The most feared complication in the clinical course of children with diabetic ketoacidosis (DKA) is the development of cerebral edema. Cerebral edema is rare (<1%) but is the leading cause of death in pediatric DKA. Many of the details about the risk factors as well as the mechanisms leading to DKA related cerebral edema are not well understood. Before we review the recent, groundbreaking study by Kupperman et al (1), examining the relationship between intravenous fluid content and rate of fluid administration in the development of DKA related cerebral edema, it’s important that we review the associated risk factors as well as the proposed mechanisms. It is important to know that the available data we are about to review comes from retrospective studies as well as case reports and case series and not from randomized control trials.

July 2, 2018

Refractory HypoxemiaNow maybe you have intubated a patient secondary to hypoxemic respiratory failure who is at high risk for the development of acute respiratory distress syndrome (ARDS). These patients, and really all patients, with exception of severe obstructive disease, I set up the ventilator to deliver 6mL/kg based on ideal body weight (not actual weight). Regardless if this is a pediatric or adult patient, I am setting up the ventilator to target 6 mL/kg of IBW. I can accomplish this with either pressure mode, where you set the pressure, but closely monitor the tidal volumes the patient is receiving.
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